Defining stress REsilience And Mindfulness Effects in Rheumatoid Arthritis (DREAMER)

定义压力恢复力和正念对类风湿性关节炎的影响 (DREAMER)

• 批准号: 10544738
• 负责人: Sarah Lynn Patterson
• 金额: $ 17.42万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10544738
• 关键词: Acute; Address; Adverse event; Affect; American; Arthralgia; Autoimmune Diseases; Biological; Blood specimen; Cardiovascular Diseases; Chronic; Chronic Disease; Clinical; Clinical Trials; Clinical assessments; Communities; Data; Disease; Disease Outcome; Disease-Modifying Second-Line Drugs; Enrollment; Equation; Fatigue; Feedback; Flare; Focus Groups; Foundations; Frequencies; Funding; Future; Goals; Immune; Inflammatory; Inflammatory Arthritis; Infrastructure; Intervention; K-Series Research Career Programs; Knowledge; Life; Longitudinal Studies; Longitudinal cohort study; Measures; Mediating; Medical; Medicine; Methods; Mind-Body Intervention; Modeling; Outcome; Pain; Participant; Patient Outcomes Assessments; Patients; Persons; Pharmaceutical Preparations; Phase; Phenotype; Physicians; Pilot Projects; Premature Mortality; Preparation; Psychological Impact; Psychological Stress; Psychosocial Stress; Questionnaires; Randomized; Randomized, Controlled Trials; Recommendation; Research; Resources; Rheumatism; Rheumatoid Arthritis; Rheumatology; Risk; Sampling; Scientist; Severities; Severity of illness; Sleep disturbances; Standardization; Stress; Symptoms; Testing; Therapeutic; Time; Training; United States; acceptability and feasibility; career development; chronic pain; cohort; design; disorder risk; evidence base; experience; follow-up; improved; improved outcome; innovation; instrument; intervention effect; intervention program; joint inflammation; mindfulness; mindfulness intervention; mindfulness-based stress reduction; patient population; perceived stress; pilot test; premature; programs; prospective; recruit; resilience; resilience factor; resilience scale; side effect; stress management; stress reduction; stress resilience; systemic autoimmune disease; systemic inflammatory response; treatment as usual; treatment strategy

ABSTRACT Rheumatoid arthritis (RA), the most common rheumatic disease, affects 1.5 million people in the United States and can lead to debilitating joint pain, functional limitations, and premature mortality. Existing treatment approaches based on immunosuppressive medications reduce disease severity but often fail to adequately control symptoms and can lead to severe adverse side effects. This proposal addresses the critical unmet need for non-pharmacologic strategies to augment medical management of RA, improve long-term clinical outcomes, and reduce disease-related symptoms. Psychological stress is postulated to exacerbate disease severity in autoimmune diseases, but few studies have prospectively examined its impact on disease activity in RA patients or the therapeutic potential of interventions that improve stress resilience in this patient group. Furthermore, while mindfulness-based interventions (MBIs), including the mindfulness-based stress reduction program (MBSR), have been shown to reduce psychological stress and pain in several chronic diseases, it remains unknown whether they represent an effective adjunctive approach for improving disease outcomes in RA. To address these significant knowledge gaps, I propose to examine the effects of stress, stress-buffering factors, and MBIs on risk of disease flares and symptom severity in RA and related autoimmune conditions. I will first identify mechanistic targets for mind-body interventions in RA by building on an actively enrolling RO1-funded longitudinal cohort study of RA patients. Aim 1 will determine whether greater negative psychological stress independently associates with increased risk of worse RA disease activity and symptom severity over time. I will further test whether stress resilience and mindfulness longitudinally correlate with better outcomes—including less severe disease activity and symptoms—to identify key targets for non-pharmacologic interventions in this patient group. In Aim 2 I will develop augmentations to the mindfulness-based stress reduction (MBSR) course for people with inflammatory arthritis, and conduct a pilot study to assess the feasibility and acceptability of an MBSR trial for improving disease outcomes in RA. This will be the first longitudinal study to examine the effects of psychological stress and stress resilience on RA disease activity. Further, this study will advance the field of integrative rheumatology by developing innovate methods to augment MBSR for people with immune-mediated inflammatory diseases. The proposed study will generate proof-of-concept data to inform a subsequent randomized controlled trial with R-level funding to test whether MBSR improves RA disease activity and symptoms. Importantly, this K23 Career Development Award will catalyze my successful transition to an independent physician-scientist with an impactful research program defining mechanisms and efficacy of MBIs in people with rheumatic conditions.

摘要 风湿性关节炎（RA）是最常见的风湿性疾病，在美国有150万人受到影响。 可能导致关节疼痛、功能限制和过早死亡。现有治疗 基于免疫抑制药物的方法降低了疾病的严重程度，但通常不能充分 控制症状，并可能导致严重的不良副作用。这项建议涉及尚未满足的关键需要， 用于非药物策略，以加强RA的医学管理，改善长期临床结局， 并减少疾病相关症状。 心理压力被认为会加重自身免疫性疾病的严重程度，但很少有研究 已经前瞻性地研究了它对RA患者疾病活动的影响或 干预措施，提高该患者群体的压力恢复能力。此外，尽管基于正念的 包括正念减压计划（MBSR）在内的心理干预（MBIs）已被证明 减少心理压力和疼痛的几种慢性疾病，它仍然不知道他们是否代表 改善RA疾病结局的有效治疗方法。为了解决这些重要的知识 差距，我建议研究压力，压力缓冲因素，和MBIs对疾病爆发风险的影响， RA和相关自身免疫性疾病的症状严重程度。 首先，我将通过建立一个积极的登记， RO 1资助的RA患者纵向队列研究。目标1将决定是否更大的负面影响 心理压力与RA疾病活动和症状恶化风险增加独立相关 随着时间的推移，我将进一步测试压力弹性和正念是否与更好的纵向相关。 结果-包括不太严重的疾病活动和疾病-以确定非药物治疗的关键靶点 对这一患者群体的干预。在目标2中，我将开发对基于正念的压力的增强 减少（MBSR）课程的人与炎症性关节炎，并进行试点研究，以评估可行性 以及正念减压疗法试验改善类风湿关节炎疾病预后的可接受性。 这将是第一个纵向研究，以检查心理压力和压力恢复力的影响 RA疾病的活动。此外，这项研究将通过发展综合流变学领域， 创新的方法来增强正念减压疗法对免疫介导的炎症性疾病患者的疗效。拟议 研究将生成概念验证数据，为后续的R级随机对照试验提供信息 该研究旨在测试正念减压疗法是否能改善类风湿关节炎的活动性和症状。重要的是，K23职业生涯 发展奖将促进我成功地过渡到一个独立的医生，科学家与 有影响力的研究计划，确定MBI在风湿性疾病患者中的机制和疗效。